Non-Local Learner Proctor Agreement
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If you are taking a Distance Learning course, live beyond a 60-mile radius from campus, and would like to test by proctor, please complete the Non-Local Learner Proctor Agreement form below.

Before completing the form, please read the Test Proctoring Procedures.

I have read and agree to the above Test Proctoring Procedures:

This Proctor Agreement form must be completed and on file with the Distance Learning office no later than the first Friday of the Quarter.
Student Agreement
As a student, I agree to the following:
  • I will be responsible for locating a proctor (exam supervisor) and scheduling appointments for exams.
  • I will be responsible for reimbursing the proctor for mailing expenses.
  • I will take the exams by the due dates assigned by the instructor.
  • I will notify the Distance Learning office if courses are added or dropped.
Date:       *Quarter:      *Year:  
 
*Student Name: 
*Student Email: 
*Tartan ID or Last 4 Digits of Social Security Number: 
 
*Address: 
*City:     *State:    *Zip Code:
*Daytime Phone Number:   
 
I would like a Placement Test: Yes    No
I would like a Proficiency Test: Yes   No   
 Course(s) Requested:

Proctor Agreement
Proctors must agree to the following:

  • Their professional position is one the following: education official, librarian, or teacher at a community college, university, elementary or secondary school; an education director at a hospital; a staff director, human services training director, test administrator, or educational services officer or any commissioned officer of higher rank than the student (military).

  • They are not a current Sinclair Community College student.
     
  • They are not a relative of the student, personal friend of the student, direct supervisor of the student, employed by the student, co-worker of the student, live at the same address as the student, nor does their position/relationship with the student present any conflict of interests.

  • They will personally administer and supervise the indicated exams, providing students access to the test only while the student is testing.

  • They will personally mail the completed exam(s) back to Sinclair Community College by the specified due dates.
*Proctor Name:
*Institution/Work:   *Official Title:
*Institution/Work Address:
*City:   *State:    *Zip Code:
*Institution/Work Phone Number:
*Institution/Work E-Mail:
 
Test Mailing Address (If different than above Institution/Work address only) -
Tests will not be sent to a private residence):
 
*Proctor Highest Academic Degree:    *Proctor Major:
Special Instructions:
*Relationship to student: (e.g., Instructor, Librarian)
Human Validation

Please type the letters as you see them in the image above. The letters are case sensitive